Professional Documents
Culture Documents
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EXTERNALJSUPERFICIAL
INGUINAL RING
Midpoint of the
"'"'"::::::.0.'"'" .]
Pubic tubercle
Pubic symphysis
'FEMORAL CANAL
SUPERFICIAL
Above and medial
INGUINAL RING
10 Ihe pubic lubercle
~------------
I.
[FiEDUCIBL!'
I~GUINAL
HERNIA
FEMORAL CANAUTRIANGLE
Below and lateral to the pubic tubercle
No cough impulse
Testicle in scrotum
No testicle in scrotum
~.
Controlled by
pressure over
Not controlled by
pressure over
intemr ring
in,emr ring
INDIRECT
DIRECT
I-,--~I
Seep.46
Unilocular
Sofllump
Traction on the testis
causes the lump 10
move downwards and
become less mobile
Transitluminales
Testis maybe
coaxed into scrotum
RETRACTILE
TESTIS
Irreduere lump
I
ENCYSTED HYDROCELE
OFTHECORD
History of hernia
No treatment if
testis goes to
bottom of scrotum
If not relocate
via inguinal incision
IRREDUCIBLE
INGUINAL HERNIA
Excision if symptomatic
~
Pain
Tenderness
Bowel obstruction
Bowel obstruction
STRANGULATED
OBSTRUCTED
See p. 46
Testis cannot be
coaxed into scrotum
UNDESCENDED,
TESTIS
Relocation
in scrotum
Orchidopexy in
neonate belore
1 year old
~----
------;/
Lymphadenopathy
Due to:
Local infection
Regional malignancy
or as part of a
generalized
lymphadenopathy
I LYMPH
I
NODE
Vascular lump:
Compressible
Blue
FillS slowly
Palpable thrill on coughing
Reduces when patient lies down
::!:. Varicose veins
I
SAPHENA
I.
VARIX
High saphenous
Rarer differe";lial
FEMORAL
diagnoSiS
PsoasabscesQ
HERNIA
ligation
Reducible
(rarely)
REDUCIBLE
FEMORAL HERNIA
Irreducible lump
IRREDUCIBLE
FEMORAL HERNIA
~
Pain
rUctiOn
Bowelobst
Tendemess
BowelObf'ruction
C-rt'D
'I
OBSTj
STRANG1ULATED
See p. 46
.~
j
I
I
LUMPS (1)
--------------------
Confined to scrotum
Not confined
10 scrotum
May be reducible
/r--
palpabte
~
I
HAEMATOCELE
Excision
bm
Controlled
Transilluminates
Theremaybea
secondary
hydrocele
present
internarring
r----------_
ULTR ASOUND
TUMOUR
HYDR OCELE
Orchidectomy through
inguinal incision
Staging, then deep X-ray therapy
and/or chemotherapy
Ex cision
by
pressure over
HYDROCELE
Testis is heavy and irregular
INGUINAL
Hisloryol:
- trauma
- drainage of hydrocele
palpable
INDIRECT
HERNIA
Not controlled
pressure over
inlernatring
DIRECT
YOu~palient
Due t~ a palenlprocessus
Tunica albuginea and
processus vaginalis
distended up to but not
through the external inguinal ring
I
INFANTILE
f'YDROCELE
vaginalis
by
See p. 46
LUMPS (2)
Transilluminates
~
Tense lump
Situated behind testis
Size very variable
May be multiple
Unilocular
Soft lump
Traction on the testis
causes the lump
to move downwards
and become less mobile
Epididymis
affected
Firm, craggy
epididymis
I
EPIDIDYMAL
CYST.
Excision
(This may render
the patient infertile)
TREATMENT
ENCYSTED HYDROCELE
OFTHECORD
Especially
'Bag of worms'
marked when standing
if symptomatic
TUBERCULOUS
EPIDIDYMITIS
VARICOCELE
Excision if symptomatic
Excision
Post-vasectomy
May be tender
SPERM GRANULOMA
Excision
if symptomatic
Antituberculous
therapy
OF HERNIAS
Operation is the treatment of choice and may be performed using general, local, epidural orspinal analgesia.
All childhood hernias are indirect and a herniotomy
is performed. This'operation is the ligation of the sac. In
the adult with an indirect hernia the posterior wall of
the inguinal canal 'is repaired in addition - herniorrhaphy. If the hernia is direct and there is therefore no
indirect sac, herniorrhaphy alone is performed.